Carboplatin-based sequential chemotherapy for advanced bladder cancer patient with impaired renal function.

Abstract

401 Background: We retrospectively evaluated the feasibility and effectiveness of a caboplatin-based sequential chemotherapy for the patients with advanced bladder cancer whose creatinine clearance (Ccr) was 60 ml/min or below. Methods: We treated 68 patients with advanced bladder cancer at our clinic between August 2004 and December 2014. 48 patients with advanced bladder cancer (33 men and 15 women) whose Ccr were 60 ml/min or below were enrolled. Their average age was 72.5 years old (43–83), average Ccr of 43.3 ml/min (14.5–57.0), and an average follow-up period of 24.5 months (5–92). The therapeutic regimen consisted of 2 lines: gemcitabine/carboplatin (GCarbo) therapy as the first line, with two courses as a set; GCarbo/docetaxel (GCarboD) therapy as the second line if the response in the first line was insufficient. GCarbo consisted of 800mg/m2 gemcitabine on days 1, 8, and 15 and carboplatin (AUC 4) on day 2. If this regimen was effective, another 2 courses of GCarbo was performed. If this regimen did not induce any tumor size reduction, we switched to GCarboD, which consisted of 800mg/m2 gemcitabine on days 1 and 8, 70mg/m2 docetaxel on day 1, and carboplatin (AUC 3) on day 2. Results: Of the 48 subjects who had undergone the GCarbo therapy, the response rate was 35.4% (CR+PR) with 3 and 14 subjects exhibiting complete response (CR) and apartial response (PR), respectively; the average response duration was 10.8 months (2–90). The response rates of 9 instances of GCardoD was 33.3%; the overall median survival was 18.0 months throughout the sequential chemotherapy. Adverse events (AE) of grade 3 or higher occurred in 30 of those who had undergone the GCarbo therapy (62.5%). Conclusions: Although the present study is small and preliminary, the present carboplatin-based sequential chemotherapy is safe and active for advanced bladder cancer with impaired renal function. GCarbo regimen achieved acceptable response rate (35.4%) in advanced bladder cancer. The median overall survival of 18.0 months is acceptable when average Ccr of 43.3 ml/min for the subjects is took into consideration.